States take action on same-day surgery
States take action on same-day surgery
In addition to a recently passed California law governing surgery in office-based settings, other action is being reported at the state level. Here are some highlights:
- More bills to require stricter safety procedures are pending in the California legislature. One would require cosmetic surgery to be performed in general acute care hospitals or specified outpatient settings only. Another would limit types of surgery depending on the level of anesthesia and type of anesthesia administered. That bill states any facility that offers a level of anesthesia above the local anesthetic or oral tranquilizer level would have to be accredited. That bill probably will pass in January, predicts Michael F. McGuire, MD, FACS, chairman of the legislative and governmental committee and national secretary for the Mundelein, IL-based American Association for Accreditation of Ambulatory Surgical Facilities. McGuire is also an associate clinical professor of surgery at University of California, Los Angeles and president of California Society of Plastic Surgeons.
- Texas has passed a same-day surgery law that has been signed by the governor. It is likely to be challenged, according to the American Association for Accreditation of Ambulatory Surgical Facilities.
The Texas law says if a facility uses sedation that has probability of putting patient at risk of loss of life-protecting reflexes, the facility must be accredited, Medicare-certified, or state licensed. "Imagine someone from the medical board trying to interpret that: the probability of putting a patient at risk of loss of life-protecting reflexes," McGuire says. "Everyone claims they’re not using that much sedation."
- The Connecticut legislature is considering a bill that will require a certificate of need (CON) for any facility that administers anesthesia.
"Once such a bill is in effect, it’s virtually impossible to build a surgery center," McGuire says. "Every application is challenged by the local hospital."
- The Virginia legislature has formed a legislative committee to consider a CON law.
- The Florida state medical board has approved rules limiting office cosmetic procedures to eight hours, requiring training for certain anesthesia, and limiting to about seven quarts the amount of fat removed.
The initial rules were much stricter, McGuire says. The rules have not been implemented, probably because they are being challenged, he adds. "Now hospitals are trying to get [the rules] back to the legislature. They want to require more rigid limits. It’s also being challenged by anesthesiologists who want to prevent CRNAs from doing surgery in ASCs."
- The New Jersey medical board has a requirement, not yet implemented, for credentials from office-based surgeons using certain levels of anesthesia. New Jersey is the first state to approve such a requirement. Full implementation of this requirement has not occurred, according to McGuire.
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